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2013 | Buch

Clinical Image-Based Procedures. From Planning to Intervention

International Workshop, CLIP 2012, Held in Conjunction with MICCAI 2012, Nice, France, October 5, 2012, Revised Selected Papers

herausgegeben von: Klaus Drechsler, Marius Erdt, Marius George Linguraru, Cristina Oyarzun Laura, Karun Sharma, Raj Shekhar, Stefan Wesarg

Verlag: Springer Berlin Heidelberg

Buchreihe : Lecture Notes in Computer Science

Enthalten in: Springer Professional "Wirtschaft+Technik" , Springer Professional "Technik" , Springer Professional "Wirtschaft"

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Über dieses Buch

This book constitutes the thoroughly refereed post-workshop proceedings of the International Workshop on Clinical Image-based Procedures: From Planning to Intervention, CLIP 2012, held in Nice, France, in conjunction with the 15th International Conference on Medical Image Computing and Computer-Assisted Intervention, MICCAI 2012. This successful workshop was a productive and exciting forum for the discussion and dissemination of clinically tested, state-of-the-art methods for image-based planning, monitoring and evaluation of medical procedures. The 16 papers presented in this volume were carefully reviewed and selected from 24 submissions.

Inhaltsverzeichnis

Frontmatter

Head Motion Compensation for Arterial Spin Labeling Using Optical Motion Tracking

Abstract

Monitoring of Brain perfusion using Arterial Spin Labeling (ASL) during thrombolysis is an example of an MR procedure that will take over one hour. During this time, patient head motion is inevitable. Among the solutions to this problem is motion tracking, which is used to provide the patient’s head motion to the MRI scanner to compensate for this motion. We present an approach for head motion tracking which is designed to fit into clinical workflow: Blue paper dots are attached to the patient’s forehead and tracked using a stereo camera setup which is mounted to the MRI head coil and easily removed and replaced. The core algorithms are explained and evaluated. Results from clinical experiments conclude the evaluation.

Martin Hoßbach, Johannes Gregori, Stefan Wesarg, Matthias Günther

Intervention Planning of Hepatocellular Carcinoma Radio-Frequency Ablations

Abstract

We present a software solution for planning and simulating radio-frequency ablation (RFA) treatment for patients suffering from hepatocellular carcinoma. Our software provides the graphical front-end for the results of the EU FP7 project IMPPACT. The main planning application was designed to assist with the identification of minimum-risk setups for RFA probes and generation of evaluable 3D representations of the predicted necrosis zones. Patient-specific mesh data describing the involved anatomic structures are used to individually parameterize the simulation procedure for personalized results. Our software supplies tools for extracting the required anatomic meshes from computed tomography (CT) images and for specifying custom intervention protocols. Data collected during simulations allow for detailed illustration of expected effectiveness and progress of heat-induced necrosis over time. Our software was evaluated positively by medical personnel and has been successfully put into practice at two independent European clinical sites.

Bernhard Kerbl, Philip Voglreiter, Rostislav Khlebnikov, Dieter Schmalstieg, Daniel Seider, Michael Moche, Philipp Stiegler, Rupert H. Portugaller, Bernhard Kainz

A Flexible Surgical Tool Localization Using a 3D Ultrasound Calibration System for Fetoscopic Tracheal Occlusion (FETO)

Abstract

In fetoscopic tracheal occlusion (FETO) surgery, the localization of a flexible tool has an important role in easing high demands for surgeons. In this paper, a point-based 3D ultrasound (US) calibration system is proposed for localizing the surgical tool, based on real-time 3D US images, an electromagnetic (EM) tracking device, and a novel cones’ phantom. A 3D US probe attached with an EM sensor is used to acquire the 3D US images of the surgical tool; meanwhile, an EM transmitter is fixed at a certain point in the environment as the origin of the world coordinate system. From these 3D US images, the skeleton of the surgical tool is extracted, and 15 labeled points along the surgical tool are then distinguished, whose coordinates in the world coordinate system are calculated by the proposed 3D US calibration system. The results demonstrate that our proposed approach achieves high localization accuracy, i.e. the average TRE of TRE of 1.99±0.49mm and the maximum TRE of 2.61±0.49mm which satisfy the requirement of the FETO surgery: less than 3.85 mm.

Rong Xu, Jun Ohya, Bo Zhang, Yoshinobu Sato, Masakatsu G. Fujie

Analysis of Structural MRI Data for the Localisation of Focal Cortical Dysplasia in Epilepsy

Abstract

Focal Cortical Dysplasia (FCD) is an anatomic malformation of the cortex that gives rise to epilepsy and in most cases can be treated surgically. The precise pre-surgical localisation of FCD is pivotal for a successful intervention that will lead to seizure freedom. The most useful brain imaging method is MRI, but the specificity of its localisation remains a challenging task. In this work multiple features intended to represent intensity, texture and form are extracted from T ₁-weighted and FLAIR images of normal and patient data. A final probability map is performed to highlight FCD lesion(s). The data from 11 most recently visited patients in our clinic and 20 controls have been acquired and examined. In all patient cases the probability map highlights the lesions with high accuracy and improved compared to other methods.

Maddalena Strumia, Georgia Ramantani, Irina Mader, Jürgen Henning, Li Bai, Stathis Hadjidemetriou

Automatic Detection and Quantification of Mitral Regurgitation on TTE with Application to Assist Mitral Clip Planning and Evaluation

Abstract

Mitral regurgitation (MR), characterized by reverse blood flow during systole, is one of the most common valvular heart diseases. It typically requires treatment via surgical (mitral valve replacement or repair) or percutaneous approaches (e.g., MitraClip). To assist clinical diagnosis and assessment, we propose a learning-based framework to automatically detect and quantify mitral regurgitation from transthoracic echocardiography (TTE), which is usually the initial method to evaluate the cardiac and valve function. Our method leverages both anatomical (B-Mode) and hemodynamical (Color Doppler) information by extracting 3D features on multiple channels and selecting the most relevant ones by a boosting-based approach. Furthermore, the proposed framework provides an automatic modeling of mitral valve structures, such as the location of the regurgitant orifice, the mitral annulus, and the mitral valve closure line, which can be used to assist medical treatment or interventions. To demonstrate the performance of our method, we evaluate the system on a clinical dataset acquired from MR patients. Preliminary results agree well with clinical measurements in a quantitative manner.

Yang Wang, Dime Vitanovski, Bogdan Georgescu, Razvan Ionasec, Ingmar Voigt, Saurabh Datta, Christiane Gruner, Bernhard Herzog, Patric Biaggi, Gareth Funka-Lea, Dorin Comaniciu

A Prospective Evaluation of Computer-Assisted Deep Brain Stimulation Trajectory Planning

Abstract

Careful planning of deep brain stimulation (DBS) insertion trajectories is key to minimizing risks of surgery-related complications such as hemorrhages, cerebrospinal fluid leakage and loss of function. Recently, some computer-assisted frameworks were proposed and retrospectively validated to demonstrate superior optimization of many surgical constraints in comparison to manual trajectory planning by the neurosurgeon. However, limited data is available on the assessment of whether these computed trajectories prospectively translate to surgical lead insertions. This work presents the clinical integration of a prototype frameless neuronavigation platform and of a new software module, named CAPS (Computer-Assisted Path-planning Software), within the overall DBS surgical workflow. A prospective evaluation on 8 DBS cases reveals that the use of CAPS can influence the surgeon’s decision-making. For 7 out of 8 cases, the surgeon performed the lead insertion based on a surgical plan obtained using CAPS and 3 of these plans differed significantly, in lead orientation, from those identified manually using an FDA-approved Medtronic StealthStation^® system.

Silvain Bériault, Simon Drouin, Abbas F. Sadikot, Yiming Xiao, D. Louis Collins, G. Bruce Pike

Method for 3D-2D Registration of Vascular Images: Application to 3D Contrast Agent Flow Visualization

Abstract

Endovascular image guided interventions involve catheter navigation through the vasculature to the treatment site under guidance of live 2D projection images. During treatment materials are delivered through the catheter that requires information about the blood flow direction, obtained by injecting contrast agent and observing its propagation on the live 2D images. To facilitate navigation and treatment the information from the live 2D images can be superimposed on a 3D vessel tree model, extracted from pre-interventional 3D images. However, the 3D and live 2D images first need to be spatially corresponded by a 3D-2D registration. In this paper, we propose a novel 3D-2D registration method based on matching orientations of 3D vessels’ centerlines to the edges of live 2D images. Results indicate that the proposed 3D-2D registration is highly robust and feasible for real-time execution (<1 s). Example of 3D contrast flow visualization also demonstrates the potential for real clinical application.

Uroš Mitrović, Žiga Špiclin, Boštjan Likar, Franjo Pernuš

Towards Automatic Path Planning for Multi-port Minimally-Traumatic Lateral Skull Base Surgery

Abstract

We investigate a multi-port minimally-traumatic approach for lateral skull base surgery. Our long-term goal is to automatically determine the best combination of three paths from the skull surface to the surgical target. Since this multi-port approach is not yet in clinical use, it is difficult to define what the best combination of paths is. Therefore, we present a planning tool which allows to manually select a combination of three paths. A clinician used this planning tool to select the best combination of three paths for three target structures in computed tomography data sets of 20 patients. From this choice we derived initial constraints for an automatic planning of the best combination of paths.

Meike Becker, Ralf Gutbell, Igor Stenin, Stefan Wesarg

Automated Segmentation and Anatomical Labeling of Abdominal Arteries Based on Multi-organ Segmentation from Contrast-Enhanced CT Data

Abstract

A fully automated method is described for segmentation and anatomical labeling of the abdominal arteries from contrast-enhanced CT data of the upper abdomen. By assuming that the regions of the organs and aorta have already been automatically segmented, the problem is formulated as extracting and selecting the optimal paths between the organ and aorta regions based on a basic anatomical constraint that arteries supplying blood to an organ consist of tree structures whose root nodes are located in the aorta region and leaf nodes in the organ region. Using the constraint, the proposed method solves both of artery segmentation and anatomical labeling. In addition, the method is robust against topological variability of the branching patterns. Experimental results using 10 datasets demonstrate that the proposed method was effectively applied to several kinds of the abdominal arteries, which include the hepatic, splenic, and renal arteries. The average F-measure, which is a normalized accuracy measure taking both false positives and true negatives into account, was 0.89 for the proposed and 0.74 for the previous methods. The method could also effectively deal with topological variability of the hepatic and renal arteries.

Yuki Suzuki, Toshiyuki Okada, Masatoshi Hori, Futoshi Yokota, Marius George Linguraru, Noriyuki Tomiyama, Yoshinobu Sato

Technical Evaluation of a Third Generation Optical Pose Tracker for Motion Analysis and Image-Guided Surgery

Abstract

Laparoscopic instrument tracking systems are an essential component in image-guided interventions and offer new possibilities to improve and automate objective assessment methods of surgical skills. In this study we present our system design to apply a third generation optical pose tracker (Micron- Tracker®) to laparoscopic practice. A technical evaluation of this design is performed in order to analyze its accuracy in computing the laparoscopic instrument tip position. Results show a stable fluctuation error over the entire analyzed workspace. The relative position errors are 1.776±1.675 mm, 1.817±1.762 mm, 1.854±1.740 mm, 2.455±2.164 mm, 2.545±2.496 mm, 2.764±2.342 mm, 2.512±2.493 mm for distances of 50, 100, 150, 200, 250, 300, and 350 mm, respectively. The accumulated distance error increases with the measured distance. The instrument inclination covered by the system is high, from 90 to 7.5 degrees. The system reports a low positional accuracy for the instrument tip.

Juan A. Sánchez-Margallo, Francisco M. Sánchez-Margallo, José B. Pagador, Ignacio Oropesa, Marcos Lucas, Enrique J. Gómez, José Moreno

Personalized Surgical Planning to Support Interventions and Training of Surgeons

Biomodels for Planning and Guidance

Abstract

An innovative system called VirSSPA that generates personalized patients biomodels in virtual reality and physicals material to plan, support the decision making and guidance of surgical processes is presented. VirSSPA began with a R&D project financed by the Andalusia Department of Health. In this paper the image analysis, segmentation and modeling performed in VirSSPA are explained. Also, a system for surgical knowledge Management was developed. Furthermore, a review of the use of VirSSPA and its applicability in 9 different surgical specialties is shown. VirSSPA has been successfully used in more than 580 real cases. A clinical study of the results obtained in using VirSSPA shows that the complication rate was reduced by 45 % and by two hours in the operating room time in breast microvascular reconstruction by DIEAP free flap.

Cristina Suárez-Mejías, Gorka Gómez-Ciriza, Purificación Gacto-Sánchez, Tomás Gómez-Cía, Carlos Parra-Calderón

Ultrasound B-Mode Segmentation for Registration with CT in Percutaneous Hepatic Interventions

Abstract

Multimodal registration of intraoperative ultrasound and preoperative computed tomography imaging is the basis for percutaneous hepatic interventions. Currently a rigid registration is performed manually by the surgeon using vessel structures and other anatomical landmarks for visual guidance. In this work we are presenting our approach for automation of this intraoperative registration step. Our method relies on the vessel structures visible in contrast enhanced CT and ultrasound B-Mode volumes. Therefore, an important part of this work is the intraoperative segmentation of vessel structures from ultrasound. For the nine randomly chosen patients studied in this paper, our system achieves a 3.45 mm accuracy for the points used for registration (target registration error (TRE)) and 5.01 mm for other landmarks which were not used for the registration process (fiducial registration error (FRE)). Of a total number of 27 patients, our system worked successfully in 15 cases.

Matthias Keil, Cristina Oyarzun Laura, Stefan Wesarg

Computer-Based Quantitative Assessment of Skull Morphology for Craniosynostosis

Abstract

In this paper we present a processing pipeline for the computational analysis of the craniosynostotic skull. Our fully automatic methodology uses a statistical shape model in order to produce diagnostic features tailored to the anatomy of the subject. We obtained an index of cranial suture closure and deformation and curvature averages across five bone segments and six suture regions automatically delineated on each subject skull. We show high correlation between these shape characteristics and our diagnostic ground truth, displaying significant differences between normal and craniosynostosis subjects, and thus suggesting the ability of our approach to provide new pathways towards the automatic diagnosis of cranysinostosis, and optimized surgical planning.

Carlos S. Mendoza, Nabile Safdar, Emmarie Myers, Tanakorn Kittisarapong, Gary F. Rogers, Marius George Linguraru

Intra-patient Non-rigid Registration of 3D Vascular Cerebral Images

Abstract

Accuracy of intensity-based non-rigid registration of vascular images is deteriorated in the presence of excessive noise as occurring in CBCT angiography. A new approach to non-rigid registration of vascular images is presented based on the assumption of isometric deformation of vessel structures. For every voxel in the vascular image, the distances along the vessels to some reference voxels are computed as features that are invariant under isometric deformation. Due to the global information on vessel connectivity that is encoded in these features, voxel-based registration of these feature images can compensate for local optima in direct intensity-based registration of the vascular images. The method is validated in the context of brain-shift mitigation, but the technique can be used more broadly. Tests on artificially deformed vascular images show that our algorithm reaches higher accuracy than traditional intensity-based registration.

David Robben, Dirk Smeets, Danny Ruijters, McElory Hoffmann, Laura Antanas, Frederik Maes, Paul Suetens

Comparison of Rigid Registration Methods in Four Clinical Scenarios

Abstract

Deformable registration algorithms need in general an appropriate initialization of the volumes that is made by rigid registration algorithms. Very often intensity based rigid registration algorithms are used which provide a good initialization for certain deformable algorithms. However when the algorithm to be used for the deformation is based on a physical approach in which forces are applied to different points of the volume those rigid registration algorithms are not the most appropriate. In this paper we present a comparison between three rigid registration approaches (distance based, curvature based and combination) which detect the areas that are highly deformed and remove them from the calculation of the initial transformation. Its usability is analyzed in four clinical scenarios, namely: livers with large deformations due to breathing, livers before and after tumor ablation, resections and open liver surgery. The results show that the combination approach performs better than the other two in cases when a tumor has been resected.

Cristina Oyarzun Laura, Pablo Bueno Plaza, Klaus Drechsler

Differences in Radiotherapy Delivery and Outcome Due to Contouring Variation

Abstract

Gross tumor volume (GTV) delineation is central for radiotherapy planning. It provides the basis of the clinical target volume and, ultimately, the planning target volume which is used for dose optimization. Manual GTV delineations are prone to intra- and inter-observer variation and automatic segmentation methods also produce different results. There is no consensus on how to account for the contouring uncertainty, but has been suggested to incorporate it into the planning target volume (PTV) margin. Current recipes for the PTV margin are based on normal distribution assumptions and are more suitable for setup and execution errors. In this study we use the GTV delineations made by 6 experienced clinicians to create delineation-specific dose plans. These dose plans are then used to calculate theoretic tumor control probabilities (TCP) differences between delineations. The results show that current margin recipes are inadequate for maintaining the same TCP despite manual delineation variation. New methods to account for delineation variation should be developed.

Christian Hollensen, Gitte Persson, Liselotte Højgaard, Lena Specht, Rasmus Larsen

Backmatter

Titel: Clinical Image-Based Procedures. From Planning to Intervention
herausgegeben von: Klaus Drechsler
Marius Erdt
Marius George Linguraru
Cristina Oyarzun Laura
Karun Sharma
Raj Shekhar
Stefan Wesarg
Verlag: Springer Berlin Heidelberg
Electronic ISBN: 978-3-642-38079-2
Print ISBN: 978-3-642-38078-5
DOI: https://doi.org/10.1007/978-3-642-38079-2

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Über dieses Buch

Inhaltsverzeichnis

Frontmatter

Head Motion Compensation for Arterial Spin Labeling Using Optical Motion Tracking

Intervention Planning of Hepatocellular Carcinoma Radio-Frequency Ablations

A Flexible Surgical Tool Localization Using a 3D Ultrasound Calibration System for Fetoscopic Tracheal Occlusion (FETO)

Analysis of Structural MRI Data for the Localisation of Focal Cortical Dysplasia in Epilepsy

Automatic Detection and Quantification of Mitral Regurgitation on TTE with Application to Assist Mitral Clip Planning and Evaluation

A Prospective Evaluation of Computer-Assisted Deep Brain Stimulation Trajectory Planning

Method for 3D-2D Registration of Vascular Images: Application to 3D Contrast Agent Flow Visualization

Towards Automatic Path Planning for Multi-port Minimally-Traumatic Lateral Skull Base Surgery

Automated Segmentation and Anatomical Labeling of Abdominal Arteries Based on Multi-organ Segmentation from Contrast-Enhanced CT Data

Technical Evaluation of a Third Generation Optical Pose Tracker for Motion Analysis and Image-Guided Surgery

Personalized Surgical Planning to Support Interventions and Training of Surgeons

Ultrasound B-Mode Segmentation for Registration with CT in Percutaneous Hepatic Interventions

Computer-Based Quantitative Assessment of Skull Morphology for Craniosynostosis

Intra-patient Non-rigid Registration of 3D Vascular Cerebral Images

Comparison of Rigid Registration Methods in Four Clinical Scenarios

Differences in Radiotherapy Delivery and Outcome Due to Contouring Variation

Backmatter

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